Cost-Effectiveness Assessment of Monitoring Abiraterone Levels in Metastatic Castration-Resistant Prostate Cancer Patients
ten Ham, Renske M.T.; van Nuland, Merel; Vreman, Rick A.; de Graaf, Laurens G.; Rosing, Hilde; Bergman, André M.; Huitema, Alwin D.R.; Beijnen, Jos H.; Hövels, Anke M.
(2021) Value in Health, volume 24, issue 1, pp. 121 - 128
(Article)
Abstract
Objectives: Abiraterone acetate is registered for the treatment of metastatic castration-sensitive and resistant prostate cancer (mCRPC). Treatment outcome is associated with plasma trough concentrations (Cmin) of abiraterone. Patients with a plasma Cmin below the target of 8.4 ng/mL may benefit from treatment optimization by dose increase or concomitant intake with
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food. This study aims to investigate the cost-effectiveness of monitoring abiraterone Cmin in patients with mCRPC. Methods: A Markov model was built with health states progression-free survival, progressed disease, and death. The benefits of monitoring abiraterone Cmin followed by a dose increase or food intervention were modeled via a difference in the percentage of patients achieving adequate Cmin taking a healthcare payer perspective. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainties and their impac to the incremental cost-effectiveness ratio (ICER). Results: Monitoring abiraterone followed by a dose increase resulted in 0.149 incremental quality-adjusted life-years (QALYs) with €22 145 incremental costs and an ICER of €177 821/QALY. The food intervention assumed equal effects and estimated incremental costs of €7599, resulting in an ICER of €61 019/QALY. The likelihoods of therapeutic drug monitoring (TDM) with a dose increase or food intervention being cost-effective were 8.04%and 81.9%, respectively. Conclusions: Monitoring abiraterone followed by a dose increase is not cost-effective in patients with mCRPC from a healthcare payer perspective. Monitoring in combination with a food intervention is likely to be cost-effective. This cost-effectiveness assessment may assist decision making in future integration of abiraterone TDM followed by a food intervention into standard abiraterone acetate treatment practices of mCRPC patients.
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Keywords: abiraterone, cost-effectiveness, food, prostate cancer, therapeutic drug monitoring, Quality-Adjusted Life Years, Abiraterone Acetate/blood, Markov Chains, Humans, Male, Antineoplastic Agents/blood, Prostate-Specific Antigen/blood, Disease-Free Survival, Drug Monitoring/economics, Cost-Benefit Analysis, Aged, Prostatic Neoplasms, Castration-Resistant/drug therapy, Public Health, Environmental and Occupational Health, Health Policy, Journal Article
ISSN: 1098-3015
Publisher: Elsevier Limited
Note: Publisher Copyright: © 2020 ISPOR–The Professional Society for Health Economics and Outcomes Research
(Peer reviewed)